Eur Heart J Qual Care Clin Outcomes. 2026 Jun 1:qcag092. doi: 10.1093/ehjqcco/qcag092. Online ahead of print.
ABSTRACT
AIMS: Guideline-recommended long-term cardiovascular disease (CVD) risk prediction models use varying time horizons. This study compared which risk horizon (risk until ages 80 or 95 years, or 30-year risk) most effectively guides preventive treatment in apparently healthy individuals.
METHODS: CVD risks for all horizon were estimated using the LIFE-CVD2 model in individuals aged 35-69 years without CVD or diabetes from the Dutch ELAN registry (2007-2024; n=364,003) and the EPIC-InterAct subcohort (1992-1998; n=8,813). Individuals in the top risk decile were compared across time horizons. Simulating blood pressure- and lipid-lowering therapy, the impact of using either time horizon was assessed by the expected gain in CVD-free life years and lifetime CVD events prevented.
RESULTS: Individuals identified by 30-year risk were predominantly older and largely overlapped with 10-year risk (46%). In contrast, risk until ages 80 and 95 years showed less overlap with 10-year risk (18% and 20%, respectively) and identified more young men in the highest risk decile. Treatment guided by risk until ages 80 and 95 years yielded a median gain of 2.6 [IQR 2.2-2.9] CVD-free life years per person treated, with prevention of 4,434 and 4,658 CVD events, respectively, compared with 1.8 [IQR 1.4-1.9] years and 4,215 events for 30-year risk. A hybrid strategy combining 10-year risk with risk until age 80 years yielded a median gain of 2.5 [IQR 2.1-3.0] CVD-free life years.
CONCLUSION: Long-term CVD risk estimation until age 80 years offers a pragmatic approach to identify younger high-risk individuals not captured by 10-year risk who may benefit from preventive treatment.
PMID:42225413 | DOI:10.1093/ehjqcco/qcag092